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9907-158 (SFD)LICENSED CONTRACTOR DECLARATION �-. I,hereby-affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 634981") 1i31,'20f Date Signature of Contr `to� ... -_ r OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: , ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044,. Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of •the following declarations: () I have and will maintain a certificate of,consent to self -insure for workers" compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. (,() I have and -will maintain°workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No.' GOLDEN EAf L.E.1tvS. IMC E32SM 02 (This section need not be completed if the permit valuation .is for $100.00 or less). () I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner'so as to become subject to the workers' compensation laws of California, and agree that if I should become"" subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ybate: 7 1r L- `� Applicantt ti Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penaltie's and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and 6atety for a permit subject'to the conditions 'and restrictions set ,forth on his application. 1. Each person upon whose behalf this application is made,& each person at whose request and for,whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ,Slgnaturef (Owner/Agent) �' ` Date I �t BUILDING PERMIT PERMIT"07 1� ` .* DATE ^ VALUATION S1,17.992.90 LOT .19ro TRACT BIM 9.2 U19 JOB SITE 5.?40 AVEIVIDA MA. EZ APN .774_ 1:1.1_01,6 ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER MtR. & MRS. ROMEKI 1t 1K.:EI. LOCiC'i ^.0 R0NEL CON' Ul t11u'.3OM. ' Li! GUINEA CA 92253 (760)564-4604 CBL# 22151 USE OF PERMIT .FAMILY UA LL�INO �SlINGLE 7;i 7f i�;l�,,�1 �1.rD �- PE12.tvf1'.C`D OESS NOT I I�IC:LUDE JOLOl.:K WALL. OR 3^L 011, 7'RutCT 00INTM.iJC,'1 IM4 1 PG avf-,J4x1© 190.00 SF li•Fllttl,Ct#J4;:t�'ftf°t;;?1t`i" ?5EJ.00 SFr �>; t. wC► 1.'eNce zco.co LF 1L'7.>al ill�Mdt��k��'Sid'1,ri.�'+.Y�S 'l.i�Sl.idi'Yi.'l�.F\G,f�ps iC..tl+�. 1�f���;e'2•�V CONSTRUCTION `FIS 101-0004i8-f1LtiU S102.g0 MAN t Hr.KFfft:, MI-00-439-319�St?ti,ry2 �S'�i MIMI iAi dF,'i`: .iVd V �a^.9.�i)l�� WWI) m' Eh.–!�-iZICAL MCI,- 101-000-420-000 SWCOA 1 PILU.MBiNQFEE 101-000419-000 Si3o.'rw rw}t S'm4N{{IIC��1��iv�C. no, NFFP,_ 12.1 siD 1ifi1J.•d/'�on-24.1-0f/l/) Qs?t11,80 M; NIG I LE 101-000-^c�23-1000 VDi.V .41� IR Nom. ' •I d t DE OPER:FAVAC'TITE SLW7.00 f PR.PT,ANT 10J-000-"1-3'13 3i0U.0U EC,tSSE «_? ART IN -PUBUC PLA TS - RES11; 701-119110-255.000 $44.99 f-0, DITO SIT 101-000-4.19-318 -$250.01 S[.•Y7 -TtYfAL 4.ONT '47 t~S<VVLaC/N AND P)•1 -EN C.t•ii:CK $3,7OS 21 LESS P!. ,; PAJD FEES 5750.00 TOTAL ftRMIT FCE� 0131-, NOW RECEIPT DATE BY° \ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ � Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 3- $- no Jr Exhaust Fans O.K to Wrap 7' F.A.U. Framing —8� 0� % Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath j Drywall - Int. Lath/rr Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs _ Electric Bond Footings L oo Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping .� ADO Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer ConnectionEncapsulation Gas Piping Gas Test g Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 57 Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) r S�%Oo " Building., Address 7r—Ti' Address City I Zip.Tel. C r) Zc l e I C �4 5 hz.-, l,v--) P.O. BOX 1504 A FlP (CAT I �j�V 7B-495 CALLE TAMPICO S LA QUINTA, CALIFORNIA 92253 • FiUUrCAJ City Zip- p ' Tear 01 6,b State Lii( ( / f' � City 8 Class'f. f�) l rtA Lic. # _22 Designer Address Tel. City (Zip ( State I Lic. q �,,.� LICENSED CONTRA"O,R'S DECLARATION I hereby affirm that I am license n er pfovisions o CIZap"fe7'g,(cc fx10) of Division 3 of the Busje; ,a Pti6fassions Code, and mv`Ih 'OWNER -BUILDER DECLARATION I hereby'af irm-that I am exempt from the Contractor's License Law for the lollowing reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to'Its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars (8500). L; I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) IA I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) i 7 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) valuation or less.) I certify that in the performance of ing work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending'agency for the performance of the work for which this permit is issued. (Sec. 3097, Civfl Code.)' Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. ` I certify that I have read this application and state that the above information is correct. I agree 10 comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned properly for inspection purposes. Signature of aQpficant Date .Mailing Address City, State, Zip WHITE = FINANCE BUILDING: TYPE'CONST. OCC. GRP. A.P. Number r % L( , I (`f — C>/2 ?.C, /I 1`– �� y Legal Descriptiori� 1c1 1Y' 1 :+ 6^•__4� 2-t% Project Description Sq. Ft. t 1 t� � Size Stories NewV/'' Add ❑ Alter ❑ on PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure " TOTAL REMAR No. Dw. Units --- Repair ❑ Demolition ❑ AMOUNT ZONE: ' BY: Minimum Set is nces: Frog�Setback from Center Line ^aQi1§V�iM tback from Rear Prop. Line �1A Side Strppt back from Center Line Sidp�S"PW om Property Line % FINAL` D , ( i�INSPECTOR ue Isstl, � = ~� —Date—Permit Validated by: Validation: "1 YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 12/10/99 No. 19740 Owner NameMr. & Mrs. Robert R. Kelloap_ Jurisdiction No, 53-600 Street Avenida Juarez city La Quinta zip 92253 APN # 774-111-026 Permit # Log # Study Area Tract # BLK192U19 Lot # Square Footage 1893 Type of Development Single Family Residence No. of Units 1 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,893 or $ 3,653.49 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CC/Union Bank of California Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Olivia Aguirre Signature Telephone 564-4604 Payment Received - . ^ $3;653.49 Check No. 6528783. NOTICE: Pursuant of Assently Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from ((�thhe date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy Applicant/Receipt Copy - Accounting V RECORDING REQUESTED BY: CHICAGO TITLE COMPANY COMPANY 99.8431KC 97055287 WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: RyyOBERT B. KELLOGG 200VHHAR OR1DOVE, UNIT 3802, SAN DIEGO, CA 92101 0 2-0 -0/ S ABOVE GRANT DEED The undersigned grantor(s).'declare(s): Documentary transfer tax is $22.00 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrance,,, ( ) Unincorporated area: ( )-City of 095563 RECEIVED FOR RECORD AT 8:OOAM MAR - 9 1999 :,=In ca.+x. ii Recorder Fe" $___ LINE FOR RECORDER'S USE APN: 774-111-026-3 ; v. lam' BOG remaining at time of sale. and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, BRADFORD H. BAILEY and RUTH JEAN BAILEY, TRUSTEES OF THE BAILEY FAMILY TRUST UAD 11/09/84 BY BRADFORD H. BAILEY AND RUTH JEAN BAILEY hereby GRANT(S) to ROBERT B. KELLOGG and SYLVIA KELLOGG, husband and wife as joint tenants DBA CONTEMPORARY HOMES the real property in the City of LA QUINTA, County of Riverside, State of California, described as: LOT 19 AND THE SOUTHERN HALF OF LOT 20, BLOCK 192 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 19, AS PER MAP RECORDED IN BOOK 19 OF MAPS, PAGES 33-34, RECORD OF RIVERSIDE COUNTY. CALIFORNIA Dated February 8, 1999 4 (L of rnc�cs State of County of S.S. On I -el 4 r before me, personally app ared 51 , (cam y 0-Ij personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s)*is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon' behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. SignaturettL�L�lrftn MAIL TAX STATEMENTS TO: SAME AS ABOVE BRADFORD W. BAILEY, TRUSTft RUTH JEAN MILEY, TRUSTEE y PCo My COMMission &P1res January 4, 2003 (This area for official notarial seal) RC Di ri - Pl n V' F This.form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to Building & Safety as your correctiori list. Please attach additional explanations as necessary. APPLICANT: CORONEL CONSTRUCTION --- • Sa PROJECT 53-560 Avenida Juarez ADDRESS: APN:. 774-111-026. LEGAL: LOT* 19—, BLOCK 1,2—, UNIT 19 S.C. @ V.L.Q. CK'D BY: Fred Baker BIN NOb . CASE NO.. 99-104 CHECK DATE: Inform the assigned Building plan checker .upoh your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y-1 N I COMMENT/CORRECTION •:Cti{\4::+{:�+`'4•'l�:ti��\�`n •.\`�.\4 M4 ��:'l`\ �4 \:i��:`�{{>� y::, v:`•• `.::\ •"`\4;�:.•i�}�:.:•,}yu i. �i { 4 � \`ikti. •.\`.Y{:n\\;\\:;:`:. �h;}���::\; \•\}l} 4 ^\. 4w,:y�•:\� :�`i\'\\..'•``••;•i:\,r:4`U.�'Y.:i:•,i•':{fi: ' :• ;:�2 n\.Tiw1:;?ti`\\'••:':?,.+:.`\:•tJ.l\:}•':.\h�,`.,':{•iv:�\�L>.\>... x^.\V�:1n^.}Z,:}.. \,\{:\•i:i•\4{.4+::1\. V R .W. 'A )f'..'f \1wv:•.vi:'n \?Sv. •`�1il?`Y,\� �;.:Y.\\Y.•.. Case logged and number assigned Verify legal and APN information Consistent with MDG on file las applicable) , Appnvrn MDG filing required (5+ filings since 9/3/98) Y �DEVEtoprg Consistency -with-street/surrounding area:.FVE URI t n IVO. Colors Materials Architecture • OTHER REQUIREMENTS: The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building .& Safety address •file. CARLOS .ELIAS REGISTERED CIVIL ENGINEER 38825 Charlesworth Drive Cathedral City, California 92234 Telephone (760) 328-7271 J,9 e, ATp2czss S3- S,o JW9-2 t'� (!V (/1 64. LLJ /0/ �0.16�39 9F CA5�1� l'JIL ��Q RESIST s A Cl,id p A �0 ca �1 833N r X 3 14 E4 0 Certificate' of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section' 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances, of the City regulating building construction or use. For the following.- BUILDING ollowing. BUILDING ADDRESS: Use Classification: SFD 53-600 AVENIDA JUAREZ Occupancy Group: R 3 Type of Construction: Owner of Building: MR. & MRS. ROBERT R. KELLOGG Building Official VN Bldg. Permit No.: 9907-158 Land Use Zone: RC Address: P.O. BOX 389 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 10-13-00 POST IN A CONSPICUOUS PLACE